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General NPI Number Information
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NPI Number | 1538475918
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Entity Type | Organization
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Legal Business Name | MEMORY LANE HEALTHCARE SERVICES, INC.
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Dates
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Enumeration Date | 08/24/2010
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 312 W UNIVERSITY DR
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City | EDINBURG
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State | TX
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Zip | 78539-3302
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Country | US
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Telephone | 956-287-2999
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Fax | 956-287-2998
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Provider Business Mailing Address
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Address Line | 1207 JOANN ST
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City | EDINBURG
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State | TX
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Zip | 78539-6017
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Country | US
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Telephone | 956-287-2999
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Fax | 956-287-2998
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LETISIA MORENO CABALLERO
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Credential | RN
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Telephone | 956-287-2999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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